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Guest Column: More accountability for hospital costs

Recently my wife had one-day surgery at Flagler Hospital and it went well. Grateful as we are for a good outcome, the final bill for just seven hours at this facility came as a rude shock. For less than a day, the hospital charged $24,900 and the physicians added bills of $2,100. Our insurance “adjusted” the hospital bill down $4,483 and paid Flagler $17,361. We paid some $4,400 with our own money. Was the billing justified?

If you have read Steven Brill’s “Bitter Pill: Why Medical Bills are Killing Us” (Time: February 20, 2013), then you know already how hospitals don’t tell you what it will cost beforehand, and they charge insurors various prices for the same thing — but all above cost.

For us, the itemized bill shows some astounding charges: Acetaminophen (Tylenol) for $133.50 (2 tablets) and so on with an additional $1,069.29 charge for use of their pharmacy. You’ve probably seen Tylenol at CVS for $.25 a tab. The operating room charges $5,600 for 75 minutes, plus $1,021 for an hour in the recovery room and, on top of that, dozens of items like sutures and tubes priced 10 to 100 times the actual cost.

Interestingly, on an annual basis, I estimate that the operating room alone would yield $11,649,000 in annual revenue. The hospital has two of them, so billing 40 hours a week M-F would provide Flagler with $23 million a year just for these two rooms. Separate billing for the recovery room, the pharmacy (on top of astronomical drug and supply charges) adds millions more. The result is a whopping bill exceeding our worst fears.

This experience adds one more confirmation that neither the insurance companies nor government, and especially not the patient, know what medical services will cost prior to agreeing to them.

Since our insurance plan pays 85 percent — we consider ourselves protected. This is clearly not the case.

As the Time magazine article shows in numerous examples, the charges are not related to costs — but are built on the sky-high Chargemaster schedule of fees. Insurors bargain to get discounts — and Medicare is the lowest. All insurors pay above costs. As a result, so called “nonprofits” are raking in millions of dollars fees above costs — and no one is willing or able to stop them. On the other hand, if Medicare or Medicaid was the insurer, the charges would have been far less.

I think it’s time we demanded up front cost estimates for health care services and cost-related fees. By giving us the chance to shop around, we could make informed choices.

After all, who would choose a car mechanic simply because he/she is closer or give that mechanic a blank check to spend without an estimate. Time to let your state and federal representatives know — and Flagler’s Board of Trustees — that we expect more accountability and consumer choice, and prices clearly related to costs.